Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: An Updated Systematic Review
Abstract
BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is associated with high blood pressure (BP), decreased kidney function, renal replacement therapy (RRT), and death. PURPOSE: To compare benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) versus medical therapy alone in adults with ARAS. DATA SOURCES: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1993 to 16 March 2016; gray literature; and prior systematic reviews. STUDY SELECTION: Randomized, controlled trials (RCTs); nonrandomized, comparative studies (NRCSs); single-group studies; and selected case reports that reported all-cause and cardiovascular mortality, RRT, kidney function, BP, and adverse events. DATA EXTRACTION: Six researchers extracted data on design, interventions, outcomes, and study quality into a Web-based database. DATA SYNTHESIS: Eighty-three studies met eligibility criteria. In 5 of 7 RCTs, PTRAS and medical therapy led to similar BP control in patients with ARAS, and no RCTs showed statistically significant differences in kidney function, mortality, RRT, cardiovascular events, or pulmonary edema. Eight NRCSs had more variable results, finding mostly no significant differences in mortality, RRT, or cardiovascular events but heterogeneous effects on kidney function and BP. Procedure-related adverse events were rare, and medication-related adverse events were not reported. Two RCTs found no patient characteristics that were associated with outcomes with either PTRAS or medical therapy. Single-group studies found various but inconsistent factors that predict outcomes. Case reports provided examples of clinical improvement after PTRAS in patients with acute decompensation. LIMITATION: Limited clinical applicability and power in RCTs, and possible publication bias and lack of adjusted analyses in NRCSs. CONCLUSION: The strength of evidence regarding the relative benefits and harms of PTRAS versus medical therapy alone for patients with ARAS is low. Studies have generally focused on patients with less severe ARAS. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
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Moderate degrees of renovascular hypertension most often can be managed with medical therapy, particularly with the use of agents that block the renin-angiotensin system (ACE inhibitors/ARBs), as several prospective randomized trials have demonstrated.
“Moderate degrees of renovascular hypertension most often can be managed with medical therapy, particularly with the use of agents that block the renin-angiotensin system (ACE inhibitors/ARBs), as several prospective randomized trials have demonstrated.309,310”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [310]
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- Authors
- Raman, G., Adam, G. P., Halladay, C. W., Langberg, V. N., Azodo, I. A., & Balk, E. M.
- Affiliations
- Tufts Medical Center (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2016-08-16
- Volume
- 165
- Issue
- 9
- Pages
- 635
- ISSN
- 0003-4819 (ISSN-L)
- OpenAlex
- W2473372812
- Cited by
- 81
- References
- 102
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 10 · 2023: 7 · 2022: 12 · 2021: 13 · 2020: 7 · 2019: 9 · 2018: 6 · 2017: 6
- FWCI
- 6.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Health Care Policy and Research (290-20-1500002 I)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- atherosclerotic renal artery stenosis, percutaneous transluminal renal angioplasty, renal artery stenting, medical therapy, blood pressure control, renal replacement therapy, renal function, cardiovascular mortality, all-cause mortality, pulmonary edema, acute decompensation, comparative effectiveness
- MeSH terms
- Adult, Antihypertensive Agents, Humans, Hypertension, Renal Artery Obstruction, Stents, Angioplasty, Renal Insufficiency, Comparative Effectiveness Research
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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